How to Treat Drug Addiction in California: A Doctor's Perspective

We believe that ER's should be gateways to treatment, and that California needs to join many other states that have already repealed the UPPL regulations that discourage physicians from diagnosing drug and alcohol abuse problems and that shield insurers, but not citizens. Assembly Member Paul Krekorian has introduced AB 1461 in an effort to carry out this recommendation.

Youth Treatment Initiative: Managed care has pretty much dismantled inpatient psychiatric services for teenagers. Yet, as many parents realize all too well, behavior problems, failing school performance, psychiatric symptoms, and drug abuse travel together in today's youth. They need treatment programs that are highly structured but not hospital-based, and at much lower cost. CSAM is preparing comprehensive recommendations for improved addiction and dual-diagnosis treatment for California youth.

Insurance Fairness for Addiction Treatment: Federal employee insurance plans have granted parity for over 5 years, and careful studies have demonstrated no increased costs overall. CSAM believes that CalPers, our state employee insurance, needs a wholesale revision of its antiquated addiction benefits.

The benefits profile is incorrectly tilted towards (expensive) inpatient care and shorts outpatient care to 20 visits a year. This needs to be re-balanced in accord with more modern ideas that show greater effectiveness from outpatient services. And, we believe that it is time to require insurance companies to provide coverage for substance abuse treatment at the same levels as they insure for other medical illnesses. The bill is AB 423, authored by Assembly Member Jim Beall, Jr.

Proposition 36, Treatment Rather Than Incarceration Initiative: I used to say that a year in a California prison cost somewhere between UC Berkeley and Stanford. Recently, I learned that at over $43,000 per year the cost of incarceration has just surpassed a year at Stanford. The week before, many of us read the devastating report from the Inspector General on the dismal state of so-called "in-custody treatment," a billion dollar boondoggle.

It reminds us that the rhetoric of treatment is not the same as real treatment. The report found that the California Department of Corrections and Rehabilitation has provided such poor drug treatment services behind bars that the services had no positive impact whatsoever, despite a $1-billion price tag. As doctors specializing in substance abuse problems, we recommend that treatment be provided within the community whenever possible. Community-based treatment is not only effective at reducing drug abuse behavior but also costs far less than incarceration.

Each year through Prop. 36, over 36,000 people convicted of a non-violent drug offense access treatment, half of them for the first time. UCLA research showed that Prop. 36 has saved California at least $800 million over five years—between $2.50 and $4 per $1 invested. And, by July 1, the program will have graduated over 72,000 people. According to UCLA, those who complete Prop. 36 treatment are twice as likely to be employed.

CSAM has opposed bogus improvements to Prop. 36, such as incarcerating participants for relapse. For some constructive improvement recommendations, turn to our website.

No Good Deed Goes Unpunished: We are acutely aware of California’s budget crisis, but the Governor’s proposal to cut funding to Prop. 36 this year is underhanded. Not only is he cutting $25 million off the top, he plans another hidden cut, by requiring county matching funds before any state spending on Prop. 36 can be dispersed. (Does anyone really believe that counties will increase sales taxes to make this happen?)

CSAM hopes that the legislature will not permit cutting the oxygen off from Prop 36. It saves money, it rescues squandered lives, and it can help us avoid building more prisons to house non-violent offenders.

Peter Banys, MD, MSc, is a member of the Executive Board of the
California Society of Addiction Medicine and the American Society of Addiction Medicine. He is a Health Sciences Clinical Professor of Psychiatry at UCSF and is listed in Best Doctors in America.